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951.
Background Appropriate management of cystic lesions of the pancreas is controversial. Major pancreatectomies (pancreaticoduodenectomy
or distal pancreatectomy with splenectomy) are the commonly used procedures, even though most cystic lesions are noninvasive
neoplasms. We tested the adequacy of limited pancreatectomies in the treatment of pancreatic cystic lesions.
Methods Data from 109 patients who underwent surgical resection of a pancreatic cystic lesion at National Taiwan University Hospital
from 2001 to 2007 were retrospectively reviewed. Major pancreatomies (n = 79) constituted pancreaticoduodenectomy and total/distal
pancreatectomies, while other resection procedures (n = 30) represented limited pancreatectomies. Clinicopathologic features
were compared between the major and limited groups.
Results There were no statistically significant differences in sex, age, presence of symptoms, cyst diameter, minor or major treatment
complications, or pancreatic leakage between the two groups. Cystic lesions located in the neck/body/tail rather than in the
head/uncinate process were significantly more often treated with limited pancreatectomy (P = .02). Both groups had similar pathologic distribution of cystic lesions, with the exception of nine invasive neoplasms.
The latter were treated with major pancreatectomy. No recurrence was noted in 100 patients with noninvasive cystic neoplasms
after major or limited pancreatectomy.
Conclusions Noninvasive pancreatic cystic neoplasms can be safely and effectively treated by limited pancreatectomy. 相似文献
952.
Ryu KW Kim YW Lee JH Nam BH Kook MC Choi IJ Bae JM 《Annals of surgical oncology》2008,15(6):1625-1631
Background Information on surgical complications of laparoscopy-assisted distal gastrectomy (LADG) and their risk factors is limited
in the literature despite increasing popularity of this procedure. This study was performed to identify the surgical complications
and their associated risk factors of LADG in early gastric cancer.
Methods LADG was performed in 347 gastric cancer patients from January 2002 to December 2006 at the Korean National Cancer Center
by four surgeons with ample experience of open gastric surgery before LADG. LADG indications for cases of gastric cancer at
our institution are preoperatively diagnosed cT1N0 or cT1N1, except in cases with an absolute indication for endoscopic resection.
Lymph node dissection of more than D1 + β was performed in all patients. Intraoperative and postoperative complications were
reviewed and their risk factors were retrospectively analyzed by prospective database information.
Results Forty complications occurred in 34 patients (9.8%), but there was no mortality. Intraoperative complications occurred in nine
patients (2.6%), and open conversion was performed in eight (2.3%) of these patients. Early and late postoperative complications
occurred in 21 (6.1%) and 10 (2.9%) patients, respectively. The most serious complication was vascular injury resulting in
bleeding or organ ischemia, which occurred in seven patients. Degree of lymph node dissection and surgical inexperience were
found to be risk factors of surgical complication (P = .023, odds ratio 2.832, 95% confidence interval 1.155–6.946 vs. P = .028, odds ratio 2.975, 95% confidence interval 1.127–7.854).
Conclusions Lymph node dissection during LADG should be performed cautiously to prevent surgical complications like vascular injuries,
especially during the surgeon’s early learning period. 相似文献
953.
Takagawa R Fujii S Ohta M Nagano Y Kunisaki C Yamagishi S Osada S Ichikawa Y Shimada H 《Annals of surgical oncology》2008,15(12):3433-3439
Background We evaluated the prognostic value of the preoperative serum carcinoembryonic antigen (CEA) level in patients with colorectal
cancer (CRC).
Patients and Methods The study group comprised 638 patients. The optimal cutoff value for the preoperative serum CEA level was determined. Predictive
factors of recurrence were evaluated using multivariate analyses. The relapse-free time was investigated according to the
CEA level.
Results All patients underwent potentially curative resection for CRC without distant metastasis, classified as stage I, II, or III.
The optimal cutoff value for preoperative serum CEA level was 10 ng/ml. Elevated preoperative serum CEA level was observed
in 92 patients. Multivariate analysis identified tumor–node–metastasis (TNM) stage and preoperative serum CEA level as independent
predictive factors of recurrence. The relapse-free survival between CEA levels >10 ng/ml and <10 ng/ml significantly differed
in patients with stage II and III. However, there was no significant difference in relapse-free survival between CEA levels
>10 ng/ml and <10 ng/ml in patients with stage I.
Conclusion Preoperative serum CEA is a reliable predictive factor of recurrence after curative surgery in CRC patients and a useful indicator
of the optimal treatment after resection, particularly for cases classified as stage II or stage III. 相似文献
954.
Daltro C Gregorio PB Alves E Abreu M Bomfim D Chicourel MH Araújo L Cotrim HP 《Obesity surgery》2007,17(6):809-814
Background Obesity is the most important risk factor for obstructive sleep apnea. It is estimated that 70% of sleep apnea patients are
obese. In the morbidly obese, the prevalence may reach 80% in men and 50% in women. The aim of this study was to determine
the prevalence and severity of sleep apnea in a group of morbidly obese patients, leading to bariatric surgery.
Methods In a cross-sectional study developed in Bahia, northeastern Brazil. 108 patients (78 women and 30 men) from the Obesity Treatment
and Surgery Center - “Núcleo de Tratamento e Cirurgia da Obesidade” underwent standard polysomnography. Patients with an apnea-hypopnea
index (AHI) ≥ 5 events/hour were considered apneic.
Results Mean ± SD for age and BMI were 37.1 ± 10.2 years and 45.2 ± 5.4 kg/m2, respectively. The calculated AHI ranged widely from
2.5 to 128.9 events/hour. Sleep apnea was detected in 93.6% of the sample, wherein 35.2% had mild, 30.6% moderate and 27.8%
severe apnea. Oxyhemoglobin desaturation was directly related to the AHI and was more severe in men.
Conclusion There was a high frequency of sleep apnea in this group of morbidly obese patients, for whom it was very important to request
polysomnography, thus enabling therapeutic management and prognostication. 相似文献
955.
Inflammatory Pseudotumor of the Spleen: Report of a Case 总被引:1,自引:0,他引:1
We report the case of an inflammatory pseudotumor of the spleen in an asymptomatic 55-year-old woman, whose lesion was accidentally found and clinically misdiagnosed to be lymphoma. An inflammatory pseudotumor of the spleen was histopathologically diagnosed following a splenectomy. This lesion is a benign, reactive, and inflammatory process and its etiopathogenesis still remains elusive. The preoperative diagnosis is difficult and the optimal management of the asymptomastic patient with the disease is unclear. This entity should be kept in mind in the differential diagnosis of splenic space-occupying lesions. 相似文献
956.
Nigel Balfour Jamieson Alan K. Foulis Karin A. Oien Euan J. Dickson Clem W. Imrie Ross Carter Colin J. McKay 《Journal of gastrointestinal surgery》2011,15(3):512-524
Background
Following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma (PDAC), identification of peripancreatic fat tumor invasion promotes a tumor to stage T3. We sought to understand better the impact of histological peripancreatic fat invasion on prognosis and site of recurrence in a cohort of patients with PDAC. 相似文献957.
Background Cancer patients undergoing major abdominal or pelvic surgery are at considerable risk of venous thromboembolism (VTE). The
genesis of thromboses in malignancy is complicated, and reflects the interaction and derangement of multiple molecular pathways.
Furthermore, the nature and location of the cancer, as well as the type surgery involved, are thought to affect the level
of VTE risk. These considerations may therefore affect treatment decisions.
Methods We performed multiple Medline searches with terms including but not limited to VTE, cancer, surgery, abdominal, colorectal,
unfractionated heparin (UFH), and low-molecular-weight heparin (LMWH) to identify reviews, meta-analyses, nonrandomized and
randomized controlled trials, and clinical guidelines relating to management of VTE in patients with abdominal cancer.
Results VTE incidence in patients with malignancy varied according to cancer type, location, stage of progression, and the use of
catheters and/or chemotherapy. Thromboprophylaxis with UFH or LMWH reduces the risk of developing VTE in these patients. However,
LMWHs have a favorable risk-benefit profile over UFH and extending the duration prophylaxis may improve outcomes.
Conclusion A number of recommendations can be made for the prevention of VTE in patients undergoing abdominal or pelvic surgery for cancer:
(1) risk-stratify all patients according to defined evidence-based guidelines; (2) for most abdominal surgical oncology patients
at risk, use of both an anticoagulant and mechanical means are indicated and beneficial; and (3) consider extended-duration
prophylaxis (up to 28 days) in those patients with major abdominal/pelvic operations and impaired mobility, preferably with
LMWH. 相似文献
958.
Background
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is currently the gold standard bariatric procedure for the treatment of morbid obesity. Laparoscopic sleeve gastrectomy (LSG) is a relatively innovative procedure which has been increasingly applied lately as a sole bariatric procedure. A randomized trial was conducted in a Greek population to evaluate perioperative safety and 3-years results. 相似文献959.
Squamous cell carcinoma of the breast is a rare type of cancer, the origin of which is still uncertain. We report a case of
squamous cell carcinoma of the breast with a recurrent tumor that showed undifferentiated features. The patient was a 55-year-old
woman who originally presented with a left breast mass in the upper outer quadrant. Echography showed a 46 × 29 × 23-mm mass
with cavity formation, and aspiration cytology confirmed a diagnosis of squamous cell carcinoma. A modified radical mastectomy
with level III lymph node dissection was performed. Pathologically, the tumor was composed of squamous cell carcinoma and
noninvasive ductal carcinoma. A recurrent tumor showing undifferentiated features was detected in the left forechest 3 months
after the operation, and tumorectomy with partial resection of the major and minor pectoralis muscles was performed. Despite
intensive therapy including chemotherapy (CEF: cyclophosphamide, epirubicin, 5-fluorouracil) and irradiation (50 Gy), the
patient died from pulmonary and skin metastases 20 months after her initial operation. The squamous cell carcinoma of the
breast in this patient grew rapidly and her prognosis was poor. Immunohistochemical findings indicated the possibility that
the squamous cell carcinoma developed from noninvasive ductal carcinoma of the comedo type, and that the undifferentiated
cells from the site of recurrence developed from dedifferentiation of the squamous cell carcinoma.
Received: August 10, 2001 / Accepted: March 5, 2002 相似文献
960.
Yamamoto S Sato Y Nakatsuka H Oya H Kobayashi T Hatakeyama K 《World journal of surgery》2007,31(6):1266-1271
BACKGROUND: Use of the inferior mesenteric vein (IMV) for partial portal decompression has not been recommended as a first-line option for intractable gastroesophageal variceal bleeding because of the thin diameter of the vein. Although these indications remain relevant, few reports have compared partial portal decompression using the IMV with other therapies. We propose that partial portal decompression using the IMV is a useful alternative treatment for intractable variceal bleeding. METHODS: We performed partial portal decompression using the IMV in eight patients with intractable variceal bleeding that had been uncontrolled using medical and endoscopic therapies. All patients were classified into Child's class B or C. The surgical data, morbidity, and mortality were assessed. RESULTS: Mean portal venous pressure significantly decreased from 26.9 +/- 2.0 mmHg before the surgery to 19.8 +/- 3.9 mmHg after the surgery. The operative mortality rate was 0%. The mean duration of hospital stay was 25.5 +/- 13.3 days. Although one patient experienced recurrent bleeding, shunt patency was well maintained in all patients during the follow-up period (mean 28.9 +/- 14.1 months). Six patients are still alive and well without ascites or hepatic encephalopathy. Two of the Child's class C patients who underwent emergency shunt died owing to hepatic decompensation. CONCLUSION: Partial portal decompression using the IMV can be a safe, effective way to treat intractable variceal bleeding in patients with liver cirrhosis. However, use of the shunt procedure may have the most survival benefits for cirrhotic patients with preserved liver function. 相似文献